THE first few years of life are delicate for rural children living in southwest China’s mountain ranges. With threadbare living conditions and little access to medicine, they often survive by the grim mantra of getting strong or getting sick.

The harsh reality of rural child-rearing hit 27-year-old farmer Han Jianying hard after she discovered her 2-year-old son experiencing bloody stools. With scarce income, Han returned to her mountain mushroom farm in the Yi minority village of Tangyang, southwest China’s Sichuan Province, less than a year after giving birth to her son, Ma Yunlong. Because normal-term breastfeeding was not an option, Han supplemented Ma’s diet with buckwheat and ghee butter before he was one month old.

With little supervision and a poor diet, Ma would often pick food from the ground with his unwashed hands, resulting in serious digestion problems from a very early age.

While Ma’s illness is easily cured with proper medical treatment, many villages in rural areas have little access to transport or hospitals. As a result, even the most easily treated sicknesses kill thousands of rural children every year.

Diarrhea is one of the most serious illnesses affecting children in China’s rural areas, taking the lives of an estimated number of 13,000 kids under 5 years old every year, according to the United Nations Children’s Fund (UNICEF).

Pneumonia, the most prevalent, kills 44,000 children under 5 every year.

“Pneumonia and diarrhea are preventable child diseases,” says Zhu Xu, a health specialist with UNICEF. “They are treated by pneumococcal vaccination and rotavirus vaccination, which are not among the free vaccines to children in China, while many developing countries have adopted those new vaccines.”

Access is a major factor for the villages. Scattered and secluded in the mountains, road access to many of the mountain villages in Muli Tibetan Autonomous County of Liangshan, where Han’s village is located, is impossible.

Delivering medicine to these areas is costly and complicated, sometimes reaching as high as 2,000 yuan (US$320), several months’ wages, for a single box of medicine.

It is even harder to see a doctor. There are stories of villagers climbing across mountains on all fours to access a nearby town where the clinic is located.

In many cases, folk remedies have taken the place of medicine, and local priests chanting sutras have taken the place of doctors.

While Ma is still surviving, this is not the case for an 8-month-old girl in the village, who, after being improperly diagnosed with food poisoning, died as a result of being mistreated with folk medicine. “She had loose bowel movements for more than a month,” recalls Padma Khamtrul, the 35-year-old village doctor.

With her parents away working on a farm and her grandparents too old to make the trip, they were unable to give the child proper treatment at a clinic.

“At first her grandparents thought it was food poisoning and gave her wild pepper, which they believed was the antidote. Then she was fed with bulrush. The baby finally died, two days before her first birthday.”

Local efforts

To battle the harsh living conditions of rural children, the government initiated a new rural medical care system that was extended to Muli in 2009. In a program that started in 2011, mothers receive 75 percent of their children’s medical costs back.

The initiative has brought in several more patients from the surrounding area, says Druma, a doctor with the People’s Hospital of Muli County, the Tibetan county where Tangyang village is located.

“In the past, the children were not brought to us until they had difficulty breathing, passed out or developed a twitch,” she says. “Now they come at earlier stages of their illness.”

“The number of children dying in the hospital from pneumonia has dropped from four or five per year before 2009 to one or two now,” she says.

Medical workers also taught villagers basic health knowledge and first-aid skills.

“Now most of them know that they should wash hands before dinner,” says Padma Khamtrul. “This is big progress. Five years ago, most only washed their faces once a week.”

Khamtrul also told villagers to use oral rehydration salts in case of diarrhea, which can be made by themselves with sugar, water and salt.

UNICEF figures showed the fatality rate of children under 5 in China has dropped from 61 per thousand to 12 since 1991. The rate was down by 71 percent in cities and 80 percent in rural areas.

“The government of China should be proud of its accomplishments, especially for children,” says Gillian Mellsop, UNICEF representative to China who just wrapped up a trip to Liangshan, adding that “its rapid progress in building an economic foundation that has lifted millions of people out of poverty, reduced under-5 mortality by three quarters ... is unprecedented in world history.”

Challenges

But it is too early to celebrate the progress. Old habits die hard, and the lack of doctors is still a haunting problem.

Tashi Yang, head of the health bureau of Muli, says that they used to have more than 100 village doctors, 60 of whom had acquired medical license.

“But the licenses have expired now, and they failed to pass the exam to get a new one, hence are now unable to prescribe medicines,” he says.

While lobbying for proper vaccinations, UNICEF is cooperating with local health authorities to train medical workers on prevention and management of pneumonia and other diseases.

Talking about the old traditions, UNICEF health specialist Dr Zhu says culturally appropriate communication strategies can pay big dividends in health education.

“In the past, Tibetan villagers would always lose their immunization record,” Zhu says. “We then put a photo of the Panchen Lama inside the record book. None of the villagers lost them again.

“Similar measures should be taken in teaching parents how to take care of their children,” Zhu adds.

For Han Jianying, the experience of potentially losing her son has already taught her an unforgettable lesson.

“I will try my best to make sure that he doesn’t eat anything not clean,” she says. “Hopefully he will work hard in the future and be a knowledgeable man. Then he will not make the mistakes I did.”